Strabismus Is Not Just a Cosmetic Concern

When people think of strabismus, appearance usually comes to mind first. Yet strabismus — especially in children — directly affects the development of the visual system, and timing is crucial in its treatment.

How does strabismus affect vision?

When the eyes are not aligned, the brain receives two different images. Adults usually experience this as double vision. Children’s brains, however, learn to suppress the image from the deviating eye to avoid confusion. If this suppression persists, amblyopia (lazy eye) develops in that eye and depth perception, which depends on both eyes working together, can be impaired.

The “they’ll grow out of it” myth

Apart from brief misalignments in the first months of life, strabismus does not resolve on its own. Some babies appear cross-eyed because of a broad, flat nasal bridge without truly having strabismus (pseudostrabismus) — only an eye examination can tell the difference. That is why the right approach is to have the eyes examined rather than wait.

Treatment options

Treatment is tailored to the type and cause of strabismus:

• Glasses: Some inward turns linked to long-sightedness (accommodative esotropia) are partly or fully corrected with the right glasses.
• Amblyopia treatment: Patching or drops improve vision in the lazy eye.
• Botulinum toxin: An injection into an eye muscle is an option in selected cases.
• Surgery: Realigning the eyes by adjusting the position or tension of the eye muscles. Strabismus surgery can be performed from infancy to old age.

Strabismus surgery is performed on the muscles on the outer surface of the eye — the inside of the eye is not entered.

Strabismus in adults

Strabismus is not only a childhood problem. Strabismus persisting from childhood or developing later can cause double vision, abnormal head posture and social difficulties in adults. With appropriate treatment, realignment is possible in adults too.

The key message: whenever an eye turn is noticed, at any age, it should be evaluated by an ophthalmologist.